Provider Demographics
NPI:1699918805
Name:SLEEP MED OF L.A., INC.
Entity type:Organization
Organization Name:SLEEP MED OF L.A., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SASAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKBAKHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-925-1145
Mailing Address - Street 1:369 S DOHENY DR # 159
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3577
Mailing Address - Country:US
Mailing Address - Phone:310-925-1145
Mailing Address - Fax:
Practice Address - Street 1:369 S DOHENY DR # 159
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3577
Practice Address - Country:US
Practice Address - Phone:310-925-1145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-17
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB8121131261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic